Clinical signs and symptoms of dehydration in children

	No dehydration	Moderate dehydration	Severe dehydration
Condition*	Well, alert	Restless, irritable	Lethargic or unconscious
Eyes^¶	Normal	Sunken	Very sunken
Tears	Present	Absent	Absent
Mouth and tongue^Δ	Moist	Dry	Very dry
Thirst	Drinks normally, not thirsty	Thirsty, drinks eagerly	Drinks poorly or not able to drink
Skin^◊	Springs back quickly	Goes back slowly	Goes back very slowly

* Being lethargic and sleepy are not the same. A lethargic child is not simply asleep: The child's mental state is dull, and the child cannot be fully awakened. The child may appear to be drifting into unconsciousness.
¶ In some infants and children, the eyes normally appear somewhat sunken. It is helpful to ask the mother if the child's eyes are normal or more sunken than usual.
Δ It is necessary to look inside the child's mouth. The mouth may be dry in a child who habitually breathes through the mouth. The mouth may be wet in a dehydrated child, owing to recent vomiting or drinking.
◊ The skin turgor, as estimated by pinch, is less useful in infants or children with marasmus or kwashiorkor.

Modified and reproduced with permission from: Treatment of diarrhea: A manual for physicians and other senior health workers. World Health Organization, Geneva, 2005. Copyright © 2005 World Health Organization.

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